International Journal of Agricultural

Science and Research (IJASR)

ISSN(P): 2250-0057; ISSN(E): 2321-0087
Vol. 6, Issue 1, Feb 2016, 299-304
TJPRC Pvt. Ltd

EFFECT OF NON-EXPOSURE TO SUNLIGHT ON VITAMIN D

STATUS OF FREE LIVING POPULATION
AFIFA JAHAN &MANORAMA KANURI
Department of Food and Nutrition, Post Graduate and Research Centre, Professor
Jayashankar Telangana State Agricultural University, Rajendranagar, Hyderabad, India
ABSTRACT
Vitamin D can play a role in decreasing the risk of many chronic illnesses. Vitamin D deficiency is pandemic,
yet it is the most under-diagnosed and under-treated nutritional deficiency in the world. 1 billion people worldwide have
Vitamin D deficiency or insufficiency. The purpose of the study to analyze the vitamin D level of free living population
who were not exposed to sunlight and effect of supplementation. A total of 20 subjects within the age group of 22-60
years were selected for the study. 20 subjects, who were not exposed to sunlight at all during the day, were selected from a
call center at Hi-tech city, Hyderabad. In places where there is a minimal sunlight, food rich in vitamin D, fortified foods
in vitamin D and vitamin D supplementation should be consumed to avoid the vitamin D deficiency. Four months

Original Article

supplementation of 60,000 IU per week was recommended for increasing serum levels to sufficiency category
KEYWORDS: Vitamin D, Minimal Sunlight, Food Rich & Nutritional Deficiency

Received: Jan 19, 2016; Accepted: Jan 25, 2016; Published: Feb 12, 2016; Paper Id.: IJASRFEB201644

INTRODUCTION
Vitamin D deficiency is pandemic, yet it is the most under-diagnosed and under-treated nutritional
deficiency in the world. 1 billion people worldwide have Vitamin D deficiency or insufficiency (Holick, 2007). It
is now recognized that the function of vitamin D extends far beyond that required for calcium homeostasis.
Vitamin D can play a role in decreasing the risk of many chronic illnesses, including common cancers,
autoimmune diseases, infectious diseases, and cardiovascular disease (Holick, 2007).
Sufficient sun exposure (usually 510 min of exposure of the arms and legs or the hands, arms, and face,
2 or 3 times per week) and increased dietary and supplemental vitamin D intakes are reasonable approaches to
guarantee vitamin D sufficiency (Holick, 2004).
Vitamin D metabolism is enhanced during pregnancy and lactation. The placenta is formed at 4 weeks of
gestation. (Hossein-nezhad, 2012, Kaludjerovic, 2010) From 4 weeks to full term, 25(OH)D3 is transferred across
the placenta, and the foetal cord blood concentration of 25(OH)D3 is positively correlated with the mothers
concentration in the blood (Shin, 2010).
Hypovitaminosis D is largely due to inadequate cutaneous production from 7-dehydrocholesterol and, to
a lesser degree, from low dietary intake or impaired intestinal absorption of the vitamin (Hollick, 2008).
Vitamin D Sufficiency via sun exposure is not a tenable solution for most Indians. Vitamin D deficiency
is a major health concern in India, notwithstanding the brightly shining sun. The adequacy of exposure to sunlight

www.tjprc.org

editor@tjprc.org

300

Afifa Jahan &Manorama Kanuri

of an individuals bare skin required to photosynthesize vitamin D is grossly ill understood. Darker skin has high melanin
content which acts as a natural sunscreen.
Therefore, darker skin produces a significantly lesser amount of vitamin D when compared with the individuals
with fairer skin, such as Caucasians (Lo, 1986, Clemens, 1982, and Matsuoka, 1991). Thus, for Indian skin tone, minimum
direct sun exposure required daily is more than 45 min to bare face, arms and legs to suns UV rays (wavelength 290
310 nm). With the exception of those who perforce the need to work outdoors in the sun, most Indians do not get adequate
sun exposure to produce sufficient amounts of vitamin D endogenously.
For a fair-skinned person, if 30 minutes of summer noon-time sun would cause mild sunburn, then 10 to 15
minutes of exposure followed by good sun protection should be sufficient to produce adequate vitamin D (Holicks, 2007).
Exposure of the face to sunlight does not serve much purpose, because although it is the most sun exposed of all the body
areas, it provides little vitamin D3.
An adult in a bathing suit exposed to 1 minimal erythemal dose (slight pinkness to the skin 24 hours after
exposure) is equivalent to taking approximately 20,000 IU (500 mg) of vitamin D2 orally (Holick, 2007 and Holick, 2012).
Thus, exposure of arms and legs to 0.5 minimal erythemal doses is equivalent to ingesting approximately 3000 IU of
vitamin D3 (Holick, 2007 and Holick, 2011).
Intake of caffeine from tea and coffee is very high in India. Studies have reported association of high caffeine
intake with increased risk of low bone mineral density, osteoporosis, and osteoporotic fractures in middle-aged women.
This situation is exacerbated in women with low calcium intake, especially in lean subjects (Beaudoin, 2011).
On the other hand, the high salt content of Indian diet is likely to increase urinary calcium excretion. A direct
relation between high sodium intake and lower bone mass has been reported (Caudarella, 2009).
In the scenario of inadequate calcium intake, vitamin D insufficiency and high phytate content in diet,
environmental pollutants such as fluoride add insult to injury.
Toxins like fluoride affect bone metabolism severely in the conjunction with inadequate calcium intake, especially
in children (Harinarayan, 2006 and Khandare, 2005).
Cooking practices in India like baking is done mostly above 175C but the temperature in the food does not reach
such high temperatures, therefore stability of vitamin D during baking is well within acceptable range (Natri, 2006).
Shallow and deep frying of foods is very popular in India. When foods are fried, vitamin D in the food comes out
into the cooking medium and is thermally degraded (Lu, 2007).
Due to all these factors which might contribute to low vitamin D status in Indians, the present study has been
designed to understand whether lack of exposure to sunlight in individuals due to occupational necessities could contribute
to low vitamin D status, and also examine the dietary factors that could further exacerbate the condition.
Methodology
A total of 20 subjects within the age group of 22-60 years were selected for the study. 20 subjects, who were not
exposed to sunlight at all during the day, were selected from a call center at Hi-tech city, Hyderabad. These subjects work
in air conditioned offices and travel by cabs to the office during late evening and return back to their home during early

Impact Factor (JCC): 4.7987

NAAS Rating: 3.53

Effect of Non-Exposure to Sunlight on Vitamin D Status of Free Living Population

301

morning before the sun rises. Their shift timings were from 7 p.m. to 4 a.m. Hence, their exposure to sunlight is almost at
zero level during week days.
Formation of Ethical Committee
An ethical committee was formed which included the doctor, a nurse, the Chairman of the advisory committee,
and the analyst. The committees approval was obtained before drawing the blood of the subjects.
Vitamin D Status was Assessed using Two Different Methods

Information on Nutritional assessment / dietary intake was collected using a questionnaire which was designed to
measure the dietary intake of all vitamin D rich food sources, quantity of intake, as well as to measure exposure of
sunlight and gain access to information about the general health status and the regular intake of any vitamin D
supplements.

Serum vitamin D levels were assessed by HPLC using a Diode Array Detector. Vitamin D status in 20 subjects
was assessed by measuring the serum concentration of 25-hydroxy vitamin D3 [25(OH)D3] by the method
described by Turpeinen et al., 2003.

RESULTS AND DISCUSSIONS

The data collected from the subjects through questionnaire method was analyzed and the results are presented in
Table no I. The results showed low consumption of milk, yoghurt, milk puddings, butter, cheese, breads, bread rolls,
wraps, fortified vitamin D products and dietary supplements. Hence, their serum vitamin D levels found before
supplementation was severely low.
The serum vitamin D levels were assessed using HPLC method described by Turpeinen et al., 2003, and were
classified according to classification given by vitamin D status National Nutrition Council (Meyer 2006) in Table II.
From the 20 subjects selected 15 were found to be severely deficient and were given 2 months supplementation of
60,000 IU/ week. After 8 weeks of supplementation, the serum vitamin D levels were assessed and the results are presented
in Table III.
Time of day during sun exposure, season, latitude, and degree of skin pigmentation dictate how much vitamin D3
is produced during sun exposure. Exposure of the arms and legs (abdomen and back when possible) to sunlight 2 to 3 times
a week for approximately 25% to 50% of the time it would take to develop a mild sunburn (minimal erythemal dose), will
cause the skin to produce enough vitamin D.
For a white person, if 30 minutes of June noon-time sun would cause mild sunburn, then 10 to 15 minutes of
exposure followed by good sun protection should be sufficient to produce adequate vitamin D (Holicks, 2007). There is no
need to ever expose the face because although it is the most sun exposed of all the body areas, it provides little vitamin D3.
An adult in a bathing suit exposed to 1 minimal erythemal dose (slight pinkness to the skin 24 hours after
exposure) is the equivalent to taking approximately 20,000 IU (500 mg) of vitamin D2 orally (Holick, 2007 and Holick,
2012). Thus, exposure of arms and legs to 0.5 minimal erythemal doses is equivalent to ingesting approximately 3000 IU
of vitamin D3 (Holick, 2007 and Holick, 2011). The subjects of the present study had zero exposure to sunlight and in
addition, consumed very low quantities of vitamin D rich foods.
www.tjprc.org

editor@tjprc.org

302

Afifa Jahan &Manorama Kanuri

Table 1: Information on Nutritional Assessment

Type of Foods Consumed
Milk
Kind of milk
Milk in tea or coffee
Breakfast cereal with milk
Milk pudding, rice pudding
or custard
Yoghurt
Butter/spread
Cheese
Cheese (all kinds) on pizza,
on toast, on lasagne or with
any other kinds of food
Bread, wraps, and/or rolls
Kind of toast/bread/rolls
Fish
Meat
Eggs
Cakes, chocolate and/or
biscuits
Alcohol
Carbonated drinks
Beverages fortified with
vitamin D and/or calcium
Dietary supplements
Use sunscreen

No Exposure Group(% of Subjects)

40% consume milk
80% Whole milk, 20% semi skimmed milk.
60% consume
90% do not consume
20% consume
20% consume
10% consume.
10% consume.
10% consume.
15% consume
From 15% 5%white bread, 5% Brown bread
and 5% consume Both
60% consume
90% consume
95% consume
40% consume
100% do not 90% consume
100% consume
10% consume
10% consume
15% use

The above table shows the regular dietary intake of Vitamin D by the selected subjects. It is clearly shown that the
consumption of Vitamin D rich foods, fortified products and Dietary supplements of D3 was very, even low though these
subjects were from higher income group and they can afford to purchase Vitamin D rich foods, but due to lack of interest
and knowledge of importance of vitamin D, ignorance is more. Hence, these subjects can be compared with low income
group where affordability of products are low due to food insecurity.
Table 2: Vitamin D Status as Per the Classification of the
National Nutrition Council (Meyer 2006)
25(Oh)D In Serum or
Plasma
>50 nmol/l*
25-50 nmol/l
12.5-25 nmol/l
<12.5 nmol/l

Description
Sufficient
Suboptimal
Deficiency
severe deficiency

Table 3: Vtamin D3 Levels before and after Supplementation

Subject No.
1
2
3
4
5
6
Impact Factor (JCC): 4.7987

Vitamin D Levels Before

Supplementation
(Severely Deficient)
7.75
7.7
8.11
5.4
8.02
5.4

Vitamin D Levels after

Supplementation
(Insufficient)
15
10
14
17.5
11.2
7.8
NAAS Rating: 3.53

Effect of Non-Exposure to Sunlight on Vitamin D Status of Free Living Population

7
8
9
10
11
12
13
14
15

Table 3: Contd.,
5.5
2
8.14
7.5
5.7
8.8
8.1
5.5
9.7

303

17
11
9
10
13
15
12
19
21

The above table shows the vitamin D levels before and after supplementation for two months. It is shown that
before supplementation 15 out of 20 were severely deficient and after supplementation for 2 months their serum vitamin D
levels were increased and they could now be classified under insufficient category. with respect to serum vitamin D3
levels. It is evident that more 2 months supplementation is recommended for increasing serum levels to sufficiency
category.
Statistical Analysis
The results of the study were analyzed statistically using a paired Ttest for assessing improvement in vitamin D3
status after supplementation. There was found to be a significant difference between the serum levels before and after
supplementation (p<0.01).
It was observed that t(cal) value was 6.23 and t(tab)value was1.76, P=1.09E-05 in one tail pair t-test. Hence it can
be concluded that it is significant at 1% level. In two tail pair t-test t(cal)= 6.23 and t (tab)= 2.14 and P=2.18E-05,
significant at 1% level.

CONCLUSIONS
The current policy of sun avoidance is creating probable harm for the general population. Ignorance of the effects
of portions of the solar spectrum at wavelengths longer than the ultraviolet is due mainly to lack of suitable measurement
tools for cutaneous and systemic responses to those regions. But in places where there is a minimal sunlight, food rich in
vitamin D, fortified foods in vitamin D and vitamin D supplementation should be consumed to avoid the vitamin D
deficiency. More 2 months supplementation is recommended for increasing serum levels to sufficiency category
REFERENCES
1.

Beaudoin, M. S., Graham, T. E. 2011. Methylxanthines and human health: Epidemiological and experimental evidence.
Handb. Exp. Pharmacol. 200, 509548.

2.

Caudarella, R., Vescini, F., Rizzoli, E., Francucci, C. M. 2009. Salt intake, hypertension, and osteoporosis. J. Endocrinol.
Investig. 32, 1520.

3.

Harinarayan, C. V., Kochupillai, N., Madhu, S. V., Gupta, N., Meunier, P. J. 2006. Fluorotoxic metabolic bone disease: An
osteo-renal syndrome caused by excess fluoride ingestion in the tropics. Bone. 39, 907914.

4.

Holick, M. F., Chen, T. C., Lu Z, Sauter E. 2007. Vitamin D and skin physiology:a D-lightful story. J Bone Miner Res.
22(suppl 2):V28-V33.

5.

Hollick, M. F. 2007.Vitamin D deficiency. N Engl J Med . 357:266-281.

6.

Holick, M. F. 2004. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and

www.tjprc.org

editor@tjprc.org

304

Afifa Jahan &Manorama Kanuri

cardiovascular disease. Am J Clin Nutr. 80 (6, suppl):1678S-1688S.
7.

Hollick, M. F, Chen, T. C. 2008. Vitamin-D deficiency a worldwide problem with health consequences. Am J Clin Nutr . 87 :
1080S-6S.

8.

Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., et al. 2011. Evaluation, treatment, and prevention of vitamin D
deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 96 (7):1911-1930.

9.

Holick, M. F. 2011. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets. 12 (1):4-18.

10. Holick, M. F. 2012. Evidence-based D-bate on health benefits of vitamin D revisited. Dermatoendocrinol. 4 (2):183-190.
11. Holick, M. F. 2012 Vitamin D: extraskeletal health. Rheum Dis Clin North Am. 38 (1):141-160.
12. Holick, M. F. 2012. The D-lightful vitamin D for child health. JPEN J Parenter Enteral Nutr. 36 (1, suppl):9S-19S.
13. Holick M. F. 2012. Nutrition: Diabetes and Death Defying vitamin D. Nat Rev Endocrinol. 8(7):388-390.
14. Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., et al. 2012. Guidelines for preventing and treating vitamin D deficiency
and insufficiency revisited. J Clin Endocrinol Metab. 97(4): 1153-1158.
15. Hossein-nezhad, A., Holick, M., F. 2012. Optimize dietary intake of vitamin D: an epigenetic perspective. Curr Opin Clin Nutr
Metab Care. 15 (6):567-579.
16. Kaludjerovic, J., Vieth, R. 2010. Relationship between vitamin D during perinatal development and health. J Midwifery
Womens Health. 55(6):550-560.
17. Khandare, A .L., Harikumar, R., Sivakumar, B. 2005. Severe bone deformities in young children from vitamin D deficiency and
fluorosis in Bihar-India. Calcif. Tissue Int. 76, 412418.
18. Lu, Z., Chen, T. C., Zhang, A., Persons, K. S., Kohn, N., Berkowitz, R., Martinello, S., Holick, M. F. 2007.An evaluation of the
vitamin D3 content in fish: Is the vitamin D content adequate to satisfy the dietary requirement for vitamin D? J. Steroid
Biochem. Mol. Biol. 103, 642644.
19. Natri, A. M., Salo, P., Vikstedt, T., Palssa, A., Huttunen, M., Karkkainen, M. U., Salovaara, H., Piironen, V., Jakobsen, J.,
Lamberg-Allardt, C.J. 2006. Bread fortified with cholecalciferol increases the serum 25-hydroxyvitamin D concentration in
women as effectively as a cholecalciferol supplement. J. Nutr. 136, 123127.
20. Shin, J. S., Choi, M. Y., Longtine, M. S., Nelson, D. M. 2010. Vitamin D effects on pregnancy and the placenta. Placenta. 31
(12):1027- 1034.
21. Turpeinen, U. et.al. 2003. Determination of 25-Hydroxyvitamin D in Serum by HPLC and Immunoassay. Clinical Chemistry.
49 (9) 1521-1524.

Impact Factor (JCC): 4.7987

NAAS Rating: 3.53